Provider Demographics
NPI:1548328073
Name:CERBASI, MARGARET MARY
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:CERBASI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 BUCKEYE AVE
Mailing Address - Street 2:
Mailing Address - City:KELSEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95451-9181
Mailing Address - Country:US
Mailing Address - Phone:707-279-4871
Mailing Address - Fax:
Practice Address - Street 1:15145 LAKESHORE DRIVE
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422
Practice Address - Country:US
Practice Address - Phone:707-994-7090
Practice Address - Fax:707-994-7096
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health